The objective of this proposal is to extend emergency response skills to communities with limited English proficiency (LEP) by investigating strategies for effective dissemination of bystander CPR (Cardio- pulmonary resuscitation) skills to LEP communities. Bystander CPR has been proven to reduce mortality from cardiac arrest. Unfortunately, individuals from different ethnic communities are less likely to receive bystander CPR, possibly due to insufficient dissemination of CPR training to these populations. A recent survey showed that Latino and Asian participants were less likely to report CPR training than other ethnic groups in one large metropolitan community. In addition, research shows that CPR instructions provided by 9-1-1 dispatch operators during a cardiac emergency are less likely to be accepted and performed by LEP callers compared to non-LEP callers. Where bystanders do perform CPR, the time-interval between onset of the emergency call and onset of bystander CPR is more than a minute longer for LEP callers than non-LEP callers. Telephone- assisted CPR has been shown to reduce mortality from cardiac arrest and as such the lack of understanding of CPR instructions or significant delays in communication of instructions may negatively affect health outcomes. Proposed primary research activities include 1) focus group research with Asian and Latino LEP individuals to investigate awareness and acceptability of bystander CPR and preferred channels for dissemination of basic CPR skills training, 2) experimental research to test linguistically adapted 9-1-1 operator-assisted CPR instructions on understanding and performance of CPR among LEP and non-LEP individuals during a simulated cardiac arrest, and 3) observational research activities including 9-1-1 tape abstraction to evaluate the implementation of linguistically adapted dispatch-assisted CPR instructions in two large call centers in the Pacific Northwest over a 9-month period. Secondary aims are to investigate the feasibility of video-based dissemination strategies for reaching Asian and Latino communities with basic CPR training and dissemination of research results to other communities. All study activities are designed to involve community partners as well as representatives of LEP populations in Asian and Latino communities. Although CPR is only one of many emergency preparedness and response techniques, both the evidence for benefit from bystander CPR as well as the health disparities that exist in rates of bystander CPR justify this focus. The results of the proposed research activities will lead to immediate changes at the "system- level" as new dispatch telephone instructions will become standard policy at the participating call centers after evaluation. In addition, the results will illuminate potential communication and dissemination strategies for reaching LEP communities with other types of emergency preparedness and response information. PUBLIC HEALTH RELEVANCE: Extending Emergency Response Skills to Limited English Proficiency Communities. The objective of this proposal is to investigate effective communication strategies for dissemination of CPR training and instructions to limited English proficiency (LEP) communities by 1) evaluating linguistically adapted 9-1-1 dispatch-assisted CPR instructions (T-CPR) on understanding and performance of CPR among LEP communities and 2) investigating the feasibility of video-based dissemination strategies for reaching Asian and Latino communities with basic CPR training. The results of the proposed research activities will lead to immediate changes at the "system-level" (i.e., new dispatch telephone instructions that will become standard policy after evaluation)and will shed light on potential communication and dissemination strategies for reaching LEP communities with other types of emergency preparedness and response information.